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Updated: Jun 3, 2026
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Published on: September 27, 2024
Perioperative Risk Stratification in Surgically Treated Endometrial Cancer: The Impact of Nutritional Status and
Murat Cengiz1, Onur Can Zaim2, Bilal Esat Temiz2
1Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey. drmuratcengizgyn@gmail.com.
Background:
To compare outcomes between older (≥ 70 years) and younger (< 70 years) patients with surgically treated endometrial cancer, evaluating the Prognostic Nutritional Index (PNI), Systemic Immune-Inflammation Index (SII), and Age-Adjusted Charlson Comorbidity Index (ACCI).
Methods:
This retrospective cohort study included 319 patients who underwent surgery at a tertiary center (2014-2024). Demographics, pathology, treatment, and outcomes were analyzed. Perioperative morbidity was graded (Clavien-Dindo). Frailty (ACCI), PNI, and SII were assessed. Overall survival and disease-specific survival were analyzed in parallel; Kaplan-Meier analyses were performed overall and stratified by stage and histology. Major morbidity was analyzed with multivariable logistic regression.
Results:
Of 319 patients, 93 (29.2%) were aged ≥ 70 years. Older patients more frequently exhibited high-grade histology, advanced stage, ASA III-IV status, high ACCI, and low PNI. Admissions to the intensive care unit were higher in older patients, but major morbidity (4.3% vs. 3.5%; p = 0.60) and 30-day mortality (1.1% vs. 0.9%; p = 0.60) were comparable between groups. Low PNI demonstrated moderate discriminatory ability for major complications. In multivariable analysis, low PNI (odds ratio 5.78; p = 0.012) and ASA III-IV (odds ratio 3.89; p = 0.047) were independently associated with major morbidity, whereas age ≥ 70 was not. For overall survival, higher PNI remained protective (hazard ratio 0.48 per 5-point increase; p < 0.001) and ASA III-IV predicted worse outcomes (hazard ratio 3.80; p = 0.002); however, chronological age was not an independent predictor.
Conclusion:
Older age is associated with more aggressive tumor biology but not with higher rates of major complications. PNI and ASA class are independent predictors of major morbidity and survival and should be integrated into perioperative risk stratification rather than using chronological age alone.
